DIETARY-TREATMENT OF MILD-TO-MODERATE HYP ERCHOLESTEROLEMIA - EFFICACY OF DIFFERENT INTERVENTIONS

OBJECTIVE To compare the efficacy of brief dietary intervention by fam ily physicians in their daily practice and in group sessions to standa rd dietetic treatment in mild to moderate hypercholesterolemia. DESIGN Randomised clinical trial. SETTING Family practice clinic in a remote community. PARTICIPANTS Between September 1, 1991 and September 30, 1 992, 135 men and women between 20 and 60 years old with mild to modera te hypercholesterolemia were recruited and randomly assigned to three treatment groups to be taught the American Heart Association low fat d iet. Each participant had an LDL-C reading higher than the desirable l evel set by the Canadian Consensus Conference on Cholesterol. INTERVEN TIONS The three treatment groups received different interventions indi vidual consultations with a family physician in his office (phase I); group sessions with a physician and a dietician (phase II); and indivi dual consultations with a dietician (phase II). Participants were foll owed for 6 months with visits and blood tests every 2 months. MAIN OUT COME MEASURES Reduction in serum levels of total cholesterol, LDL-C, H DL-C, and triglycerides was measured after 2, 4, and 6 months of dieta ry treatment. Changes in risk factors (smoking, weight, level of physi cal activity) and patients' cholesterol/saturated fat index were also measured. RESULTS Ninety-nine subjects completed the 6-month regimen. The mean reduction in serum LDL-C was 0.08 mmol/L (1.8%) in Group I, 0 .07 mmol/L (1.6%) in Group II, and 0.28 mmol/L (6.3%) in Group III (P= 0.94). An LDL-C reduction of 10% or more relative to initial level was observed in 27% of participants in Group I and approximately 40% of s ubjects in the other two groups (P=0.41). Counseling resulted in a dec rease in body weight, smoking, and dietary fat consumption and an incr ease in physical activity. CONCLUSIONS Treatment by a dietician achiev ed better results and should remain the standard. Physicians should fo cus on the detection and control of other heart disease risk factors.